HomeMy WebLinkAboutCC 9 CLAIM 85-35 08-19-85A ~"~.r" ~ ! ~ A ~ CONSENT CALENDAR
8-!9-85
~ ~TE: 08/08/85 Inter-Corn
TO:
FROM:
SUBJECT:
HONORABLE MAYOR AND CITY COUNCIL,/'
JAMES G. ROURKE, CITY ATTORNEY
CLAIMANT: FEN-WICK, EMILY; D/L: 06/04/85; DATE FILED
W/CITY: 07/19/85; CLAIM NO: 85-35; CARL WARREN FILE NO:
S-42947 LFH
After investigation and review it is recommended that the above-
referenced claim be rejected and the City Clerk directed to give
proper notice of the rejection to the claimant and to the
claimant's attorney.
JGR (F 4. se )
Enclosure:
Copy of Claim
CLAIM AGAINST THE CITY OF TUSTIN
(~or Damages to Persons or'Personal Property)
Received b~ ' via
U.S. Mail
Inter-office Mail
Over the Counter
The law provldes generally that a claim must De flled wlth t~e City Cler~ o'1"
the City of Tustin within 100 days after which the incident or event occurred.
Be sure your claim is against the City of Tustin, not another public entity.
Where space is insufficient, please use additional paper and identify informa-
tion by paragraph number. Completed claims must be mailed or delivered to the
City Clerk, The. City of Tustin, 300 Centennial Way, Tustin, California 92680.
TO THE HONORABLE MAYOR AND CITY COUNCIL, City of Tustin, California:
The undersigned respectfully submits the following claim and information rela-
tive to damage to persons and/or personal property:
1. NAME OF CLAIMANT: _~m~l~ Fenwick
a. ADD~ESS OF CLAIMANT: ....
b. PHONE NO: ( c. DATE OF BIRTH: &/ _
SOCIAL DRIVERS
d. SECURITY NO: e. LICENSE NO:
2. Name, telephone and post office address to which claimant desires notices
to be sent, if other than above:
R. E. SCOT?, Attorney at Law, 777 S. ~.~n Street~ i~222~ Oranqe~ CA 92668
3. This claim is submitted against:
a. The City of Tu~tin only.
b. The following employee(s) of the City of Tustin only:
The City of Tustin and the following employee(s) of the
City of Tustin only:
t .... tL~e
Unkno~.~ at ~,4~
Occurrence or event from which the claim arises:
a. DATE: ~/4/~5 b. .TIME:Approx. i:D0 P.I~. PLACE (Exact
and specific location): 1~ block of Bryan Avenue on the side~.Ta!k
in front of the Sa=dleback Animal Hospital
d. How'and under what circumstances did damage or injury occur? Specif~
the p you claim caused
the in (Use additional paper if necessary).
Cla~ant %~a$ walki n the.s~d~wa]~ and ~r~d ~ 'F~!l ~v~r
a negligently designed and maintain access ha{Sh to teleohone
ecaioment located under the side~alk
What part n by the City, or its employees, caused the
alleged damage or in . of ~"~
ile~!igent design, maintenanc~ ~d -m~ir .... access hatch in
'5. Give a description of the injury, property damage or loss so far as is
known at the time of this claim. If there were no injuries, state "no
injuries".
Full extent of injuries unkno~.n~: eve surcery to repair a ~msg=~
corneal reattac[unent~ fractured elbow
6. Give the name(s) of the City employee(s) causing the'damage or injury:
Unkno~n at this time
7. Name and address of any other person injured: None
8. Name and address of the owner of any damaged property: l~one
9. Damages claimed: ~.
a. Amount claimed as of this date: $100,00~,~
b. Estimated amount of future costs:
c. Total amount claimed:
d. Basis for computation of amounts clal~ed'(include copies of all bills,
invoices, estimates, etc.: Medical bills uncollated at
time
10. N~ames and addresses of all witnesses, hospitals, doctors, etc.:
a. C!a~ant
b. Raluh ~ith, address un_kno~m
c. Howard Rothfeder. M.D..
St. Joh~'~ i~osPig~l~ that Santam~gbt~:oni~a,De ~%~l;utr5%aconsidering this claim:
11. ~y additional ~one
WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM! (Penal Code
Section 72; Insurance Code Section 556.0)
Executed this ~~ / day of
I have read the matters and statements made in the above claim and I know the
same ~o be true of my own knowledge, except as to those matters stated to be
upon information or belief and as to such matters I believe the same to be true.
I certify under penalty of perjury that the foregoing is TRUE AND COP~R~CT.
.~,. ~ . , 19 <~ , at Tustin, California.
Office of the City Clerk,
Tustin, California
CLAIM NO: ~' ~ ~'--
Revised 8/05/81
jGR:se:R:8/5/81 (A)
CLAIMANT ' S SIGNATURE
FEiK:iC2
DATE FILED:
/ ?.//?/',S